Stigma of mental illness among American Indian and Alaska Native Nations: historical and contemporary perspectives

North Dakota State University, Fargo, North Dakota 58078, USA.
Issues in Mental Health Nursing 01/2006; 26(10):1001-24. DOI: 10.1080/01612840500280661
Source: PubMed


Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.

    • "Although it has yet to be tested empirically, this latter hypothesis has been suggested by others. For example, Grandbois (2005) suggested that, because of historical oppression and violence, those who strongly identify as AN may reject psychotherapy due to more negative attitudes toward anything that is deemed Western. Similarly, Johnson and Cameron (2001) have suggested that, although ANs who strongly identify with their culture likely would prefer more holistic forms of treatment and traditional ways of healing, ANs who identify with the Caucasian culture likely would be more open to psychotherapy. "
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    ABSTRACT: This study sought to examine the role of current/previous treatment experience, stigma (social and self), and cultural identification (Caucasian and Alaska Native [AN]) in predicting attitudes toward psychological help seeking for ANs. Results indicated that these variables together explained roughly 56% of variance in attitudes. In particular, while self-stigma and identification with the Caucasian culture predicted a unique amount of variance in helpseeking attitudes, treatment use and identification with AN culture did not. The results of this study indicate that efforts to address the experience of self-stigma may prove most useful to improving help-seeking attitudes in ANs.
    No preview · Article · Oct 2015 · American Indian and Alaska native mental health research (Online)
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    • "Other areas of health present a similar picture. The stigma associated with mental illness persists across many cultures and causes harm, and like others, many Indigenous people are reluctant to attend and have inadequate access to health care services [13,14]. In the US, ongoing disparities in income and education and the pervasiveness of poverty all impact negatively on the mental health and wellbeing of American Indian and Alaska Native peoples and lead to early morbidity and mortality [14]. "
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    ABSTRACT: Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of 'White', Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers' past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. Racism emerged as a key issue, leading us to more deeply interrogate the role 'Whiteness' plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing--an important step in changing the discourse that places Indigenous people at the centre of the problem.
    Full-text · Article · Jun 2012 · BMC Health Services Research
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    • "However to date research about cultural beliefs of ethnic minorities about mental health is limited, especially outside North America. In North America research conducted on the cultural beliefs of ethnic minorities typically identified perceived discrimination and stigma by the authorities and the medical establishment as a barrier to mental health care and a cause for underutilisation of services, and this has continued to be the focus of this kind of research in recent years (Burgess et al 2008; Gary 2005; Grandbois 2005). This type of stigma or perceived stigma can be considered 'external'. "
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    ABSTRACT: BACKGROUND: Existing knowledge about the cultural beliefs of black and minority ethnic (BME) communities in the UK regarding stigma and mental illness is limited. MATERIAL: Data were collected in 10 focus groups, five with service users and five with laypersons, from BME communities in London. DISCUSSION: Thematic analysis identified that cultural beliefs regarding mental illness reflect four different voices present within the BME communities. CONCLUSION: The study revealed that cultural beliefs influencing both relationships with family and, consequently, help-seeking for individuals with mental illness must be considered in the development of anti-stigma interventions and when engaging communities around mental healt.
    Full-text · Article · May 2012 · International Journal of Social Psychiatry
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